please help!

ques

We live in Canada now, my husband has been a Haptitis B carrior for at least 5 years. He is postive in 1,3,5. But the liver function is OK (normal ALT). We went back to China this spring, and found out his HBV DNA is positive, and the ultrosound result turns out not very good. In that case, he began to take lamivudine in the physican's suggestion in China. Now after 2 months, we can not get a physican's prescription on lamivudine in Canada. They only check ALT and refuse to checking the HBV DNA, since ALT is OK, so not any medication is prescribed from the physicain. We don't have any lamivudine left, and the medication post was refused by Health Canada.

How can I get the prescription here, at least pursuade the physican to check my husband's HBV DNA?

liver411

First, if your husband's LFTs was normal at the time the Chinese doctor Rx-ed Lamivudine, the doctor was wrong. One must have both elevated liver function test and HBV DNA in order to get the best result for trement. Second, Lamivudine has been approved for treatment of chronic hepatitis B in Canada. The reasons his doctor didn't check his HBV DNA were probably because your husband didn't fit the lamivudine treatment since his ALT was normal, he had a positive HBVeAg, and there is no need for checking of viral load. Third, I think you have to tell his doctor or a heptologist that your husband was on Lamivudine when he was in China; ask the doctor to consider and seek his help on: your husband needs to check his viral load and HBeAg to make sure there is no drug resistance or viral mutation occurred, he needs no interruption of Lamivudine treatment for at least some time since he has already been on the medication; Else, you have to switch the doctor if it is possible with your helath insurance provider, or drive down to Mexico to make the illegal purchase, but you still face the problem of viral mutation, and board inspection; so the only way is to let his doctor to know and understand the story; hope this helps and all is well. 411

ques

liver411

Thank you very much for your explaination and suggestion. I do appriecaite it a lot.

But, what is viral load? Is it kind of blood test? Is it anything indicating drug resistance or viral mutation?

My husband'd HBeAg was positive, not sure for now, 'cause they don't even check that. Finally, the family physician agreed to refer him to a hapatits specialist, but may need to wait for a quite long time.

We may get the lamivudine in mid July ( a friend is coming over from China), that's the earliest time we could resume the medication, which means there's about one month gap after 2 months, Is that a big deal?

I know Lamivudine works better when ALT elevated. But the result from ultrosound is getting worse, and HBV DNA is high (10*6 ), he tried 干扰素 before, no good. So that seemed only way we could go.

Thanks again.

liver411

Viral load=HBV DNA quantity(amount).

The sonagram is not as accurate as CT or liver biopsy. Normally, a family physician or HMO's primary care physician doesn't know much about the details. As a patient, one must be very careful with virus mutation and histology of his/her liver, as well as other routine tests, when one is on 3T. His doctor should have a back up plan in case of mutation does occur, such as ADV off the label.

You should "push" the family doctor a bit to have him to see the liver specialist soon. Any gap during taking of medication is not ideal for treatment.